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In Vivo (Athens, Greece) 2022This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
BACKGROUND/AIM
This study performed Tc-MAG renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys.
MATERIALS AND METHODS
Renal function was assessed during a four-week post-obstruction period by obtaining planar images of Tc-MAG activity following an ear vein injection. The individual renal function was evaluated by renal scintigraphy in conjunction with histopathological and morphological examinations.
RESULTS
The renal perfusion of Tc-MAG in the right kidney with a ureteral obstruction decreased with time. The width, height, and cortical thickness of the obstructed right kidney were significantly larger than those of the left kidney. A histopathological examination four weeks after the ureteral obstruction revealed a typical pattern of urinary tract obstruction, including multiple tubules, enlargement of the interstitial area, and cytoplasmic vacuoles.
CONCLUSION
Tc-MAG renal scintigraphy provides the kidney shape and size and can identify potential obstructive and non-obstructive kidneys in rabbits.
Topics: Animals; Kidney; Rabbits; Radioisotope Renography; Radiopharmaceuticals; Technetium Tc 99m Mertiatide; Ureteral Obstruction
PubMed: 34972716
DOI: 10.21873/invivo.12692 -
Eye (London, England) Mar 2021To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora.
OBJECTIVE
To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora.
METHODS
Sixty-eight lacrimal systems of 34 patients with epiphora were prospectively studied. Patients were initially examined with syringing, followed by digital subtraction DCG and dacryoendoscopy to confirm the diagnosis. Obstructions in lacrimal pathways were evaluated by degree, location, and cause. The weighted kappa coefficient was used to compare the agreement between the tests.
RESULTS
Of the 68 lacrimal pathways, partial or complete obstructions were identified in 56 cases (82.3%) with syringing, in 38 cases (55.9%) with DCG, and in 60 cases (88.2%) with dacryoendoscopy. DCG and dacryoendoscopy showed the same result in 42 of the 68 (61.8%) lacrimal pathways. The weighted kappa value for DCG and dacryoendoscopy was 0.60 (95% CI: 0.40-0.81). The most common sites of obstruction were the common canaliculus (36.7%) and the nasolacrimal duct (28.3%) in dacryoendoscopy. Thirty-three lacrimal pathways (48.5%) were identified to have obstructions on the same level between DCG and dacryoendoscopy. Among the 30 lacrimal pathways (44.1%) that were normal by DCG, obstruction was revealed in 22 cases by dacryoendoscopy, with 11 cases in the common canaliculus. Additional useful information on the cause of obstruction and identification of multiple obstructed sites was provided by dacryoendoscopy.
CONCLUSIONS
DCG and dacryoendoscopy showed moderate agreement in detecting lacrimal pathway obstruction. Dacryoendoscopy allowed for comprehensive investigations of the lacrimal pathway and can help explain unidentified factors associated with lacrimal pathway obstruction in patients with epiphora.
Topics: Dacryocystorhinostomy; Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 32467631
DOI: 10.1038/s41433-020-0990-1 -
Journal of Critical Care Medicine... Oct 2021Endotracheal tube obstruction by a mucus plug causing a ball-valve effect is a rare but significant complication. The inability to pass a suction catheter through the...
Endotracheal tube obstruction by a mucus plug causing a ball-valve effect is a rare but significant complication. The inability to pass a suction catheter through the endotracheal tube with high peak and plateau pressure differences are classical features of an endotracheal tube obstruction. A case is described of endotracheal tube obstruction from a mucus plug that compounded severe respiratory acidosis and hypotension in a patient who simultaneously had abdominal compartment syndrome. The mucus plug was not identified until a bronchoscopic assessment of the airway was performed. Due to the absence of classical signs, the delayed identification of the obstructing mucus plug exacerbated diagnostic confusion. It resulted in various treatments being trialed whilst the patient continued to deteriorate from the evasive offending culprit. We suggest that earlier and more routine use of bronchoscopy should be employed in an intensive care unit, especially as a definitive way to rule out endotracheal obstruction.
PubMed: 34934822
DOI: 10.2478/jccm-2021-0027 -
Sleep & Breathing = Schlaf & Atmung Mar 2022Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue...
PURPOSE
Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome.
METHODS
Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated.
RESULTS
The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012).
CONCLUSIONS
Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
Topics: Adult; Aged; Electric Stimulation Therapy; Female; Humans; Hypoglossal Nerve; Male; Middle Aged; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34091793
DOI: 10.1007/s11325-021-02396-y -
International Journal of Chronic... 2017The diagnosis of chronic obstructive pulmonary disease (COPD) is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are...
BACKGROUND
The diagnosis of chronic obstructive pulmonary disease (COPD) is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are nonspecific and attributable to a variety of diseases. Confirmatory testing to verify the airflow obstruction is available but rarely used, which may result in substantial misdiagnoses of COPD. The aim of this study is to evaluate the use of confirmatory testing and assess the accuracy of the diagnosis.
METHODS
From January 2011 through December 2013, 6,018 patients with COPD as a principal or leading diagnosis were admitted at a community teaching hospital. Of those, only 504 (8.4%) patients had spirometry performed during hospitalization. The studies were reviewed by two board-certified pulmonologists to verify presence of persistent airflow obstruction. Charts of these patients were then examined to determine if the spirometry results had changed the diagnosis or the treatment plan for these patients.
RESULTS
Spirometry confirmed the diagnosis of COPD in 270 patients (69.2%) treated as COPD during their hospitalization. Restrictive lung disease was found to be present in 104 patients (26.6%) and normal in 16 patients (4.2%). Factors predictive of airflow obstruction included smoking status and higher pack-year history. Negative predictive factors included higher body mass index (BMI) and other medical comorbidities. These patients were significantly more likely to be misdiagnosed and mistreated as COPD.
CONCLUSION
Up to a third of patients diagnosed and treated as COPD in the hospital may be inaccurately diagnosed as COPD based on confirmatory spirometry testing. Factors contributing to the inaccuracy of diagnosis include less smoking history, high BMI, and associated comorbidities.
Topics: Aged; Aged, 80 and over; Diagnostic Errors; Female; Hospitalization; Hospitals, Community; Hospitals, Teaching; Humans; Inpatients; Lung; Male; Medical Overuse; Michigan; Middle Aged; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Retrospective Studies; Spirometry; Unnecessary Procedures
PubMed: 28860736
DOI: 10.2147/COPD.S139919 -
Acta Ophthalmologica Jun 2021To identify a rationale for correct surgical treatment of proximal lacrimal obstructions.
PURPOSE
To identify a rationale for correct surgical treatment of proximal lacrimal obstructions.
METHODS
Retrospective review of 775 consecutive patients (974 eyes) with proximal lacrimal obstructions, operated on with customized surgery by a senior surgeon (FMQL) from January 2003 to December 2018.
RESULTS
In case of punctal stenosis, punctoplasty was as effective as punctal dilatation with monocanalicular or bicanalicular stent (p > 0.05). In proximal canalicular obstructions, failure rate of dacrocystorhinostomy with retrograde intubation (R-DCR) was significantly higher in case of false inferior passage creation than in case of no false passage creation (p = 0.02). In mid-canalicular obstructions failure rate of R-DCR was 41.3%, and bypass surgery with Jones tube at second stage was likely. Trephination and monocanalicular intubation, performed in selected cases, had a failure rate respectively of 16.6% and 21.7% in mid and distal canalicular obstructions. Canaliculodacryocystorhinostomy (CDCR) was successful in 77% of cases of proximal common canalicular obstruction. Bypass surgery is the treatment of choice in case of no residual patency, and rates of tube extrusion were significantly reduced with the use of StopLoss Jones tubes (SLJT) (1.7%) with respect to standard tubes (12%), (p = 0.04, Fisher's exact test).
CONCLUSION
Patient history and accurate diagnosis of the site of obstruction are essential for a correct surgical choice. Less invasive techniques as trephination and intubation may be effective, but should be reserved to patients with no associated lower lacrimal obstruction. Further studies require specific randomized clinical trials, and a standardized protocol adopted by different clinical centres.
Topics: Adult; Dacryocystorhinostomy; Disease Management; Disease Progression; Female; Humans; Intubation; Lacrimal Duct Obstruction; Male; Middle Aged; Nasolacrimal Duct; Prosthesis Design; Retrospective Studies; Stents; Young Adult
PubMed: 33124177
DOI: 10.1111/aos.14632 -
World Journal of Nephrology Nov 2014Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a... (Review)
Review
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.
PubMed: 25374811
DOI: 10.5527/wjn.v3.i4.182 -
BMJ Case Reports Aug 2017A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following... (Review)
Review
A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed.
Topics: Acute Kidney Injury; Adult; Anuria; Creatinine; Humans; Hydronephrosis; Male; Staghorn Calculi; Ureter; Ureteral Calculi; Ureteral Obstruction
PubMed: 28784872
DOI: 10.1136/bcr-2016-218173 -
World Journal of Gastrointestinal... Mar 2024Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has... (Review)
Review
Colorectal carcinoma is common, particularly on the left side. In 20% of patients, obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced (stage II, III or even IV). Diagnosis is based on clinical presentation, plain abdominal radiogram, computed tomography (CT), CT colonography and positron emission tomography/CT. The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes remains unknown. For the most common left-sided obstruction, the first choice should be either emergency surgery or endoscopic decompression by self-expendable metal stents or tubes. The operative plan should be either one-stage or two-stage resection. One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma (colostomy or ileostomy). Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity. Two-stage resection (Hartmann's procedure) is safer and the most widely used despite temporally affecting quality of life. Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing. For the less common right-sided obstruction, one-stage surgical resection is more beneficial than endoscopic decompression. The role of minimally invasive surgery (laparoscopic or robotic) is a subject of debate. Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rupture and subsequent septic complications. The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates. Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes. Management plans are crucial and must be individualized to better fit each case.
PubMed: 38577464
DOI: 10.4251/wjgo.v16.i3.598 -
Veterinary Sciences Dec 2021Urine retention secondary to neoplastic obstructions of the upper and lower urinary tracts is a life-threatening condition in both humans and companion animals. Stents... (Review)
Review
Urine retention secondary to neoplastic obstructions of the upper and lower urinary tracts is a life-threatening condition in both humans and companion animals. Stents can be placed to temporarily or permanently open obstructed urinary tract lumens and are often able to be placed using minimally invasive techniques with guidance via ultrasonography or fluoroscopy. The literature for these techniques is vast for humans and growing for companion animals. The below review provides a discussion of the principles of stenting and types of ureteral and urethral stents, as well as the techniques for placing these stents in humans and companion animals.
PubMed: 35051097
DOI: 10.3390/vetsci9010013